Older Adults' Perceptions of Mobility: A Metasynthesis of Qualitative Studies.

PURPOSE OF THE STUDY: Optimal mobility is an important element of healthy aging. Yet, older adults' perceptions of mobility and mobility preservation are not well understood. The purposes of our study were to (a) identify studies that report older adults' perceptions of mobility, (b) conduct a standardized methodological quality assessment, and (c) conduct a metasynthesis of the identified studies. DESIGN AND METHODS: We included studies with community-dwelling adults aged ≥65 years, focused on perceptions of mobility pertaining to everyday functioning, used qualitative methods, and were cited in PubMed, Embase, CINAHLPlus, or Geobase databases. Study quality was appraised using the McMaster University Tool. RESULTS: Out of 748 studies identified, 12 met inclusion criteria. Overall quality of the studies was variable. Metasynthesis produced 3 overarching themes: (a) mobility is part of sense of self and feeling whole, (b) assisted mobility is fundamental to living, and (c) adaptability is key to moving forward. IMPLICATIONS: Older adults' perceptions of mobility can inform interventions that would involve actively planning for future mobility needs and enhance the acceptance of the changes, both to the older adult and the perceived response to changes by those around them.

The prevalence of bipolar disorder in general primary care samples: a systematic review.

OBJECTIVE: To obtain an estimate of the prevalence of bipolar disorder in primary care. METHODS: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method to conduct a systematic review in January 2013. We searched seven databases with a comprehensive list of search terms. Included articles had a sample size of 200 patients or more and assessed bipolar disorder using a structured clinical interview or bipolar screening questionnaire in random adult primary care patients. Risk of bias in each study was also assessed. RESULTS: We found 5595 unique records in our search. Fifteen studies met our inclusion criteria. The percentage of patients with bipolar disorder found on structured psychiatric interviews in 10 of 12 studies ranged from 0.5% to 4.3%, and a positive screen for bipolar disorder using a bipolar disorder questionnaire was found in 7.6% to 9.8% of patients. CONCLUSION: In 10 of 12 studies using a structured psychiatric interview, approximately 0.5% to 4.3% of primary care patients were found to have bipolar disorder, with as many as 9.3% having bipolar spectrum illness in some settings. Prevalence estimates from studies using screening measures that have been found to have low positive predictive value were generally higher than those found using structured interviews.

The prevalence of bipolar disorder in primary care patients with depression or other psychiatric complaints: a systematic review.

BACKGROUND: Bipolar disorder prevalence in primary care patients with depression or other psychiatric complaints has been measured in several studies but has not been systematically reviewed. OBJECTIVE: To systematically review studies measuring bipolar disorder prevalence in primary care patients with depression or other psychiatric complaints. METHODS: We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method in January 2013. We searched 7 databases using a comprehensive list of search terms. Included articles had a sample size of 200 patients or more and assessed bipolar disorder using a structured clinical interview or bipolar screening questionnaire in adult primary care patients with a prior diagnosis of depression or had an alternate psychiatric complaint. RESULTS: Our search yielded 5595 unique records. Seven cross-sectional studies met our inclusion criteria. The percentage of primary care patients with bipolar disorder was measured in 4 studies of patients with depression, 1 study of patients with trauma exposure, 1 study of patients with any psychiatric complaint, and 1 study of patients with medically unexplained symptoms. The percentage of patients with bipolar disorder ranged from 3.4%-9% in studies using structured clinical interviews and from 20.9%-30.8% in studies using screening measures. CONCLUSIONS: Bipolar disorder likely occurs in 3%-9% of primary care patients with depression, a trauma exposure, medically unexplained symptoms, or a psychiatric complaint. Screening measures used for bipolar disorder detection overestimate the occurrence of bipolar disorder in primary care owing to false positives.

Challenging issues in tuberculosis in solid organ transplantation.

Solid organ transplant (SOT) recipients are at risk for opportunistic infections including tuberculosis. Although guidelines on the management of latent tuberculosis and active tuberculosis are available, there remain a number of clinical areas with limited guidance. We discuss challenges in the diagnosis, management, and treatment of latent and active tuberculosis in SOT candidates and recipients who reside in low-tuberculosis-prevalence areas. We discuss the diagnosis of latent tuberculosis in SOT candidates/recipients using tuberculin skin tests and interferon-γ release assays and risk stratification of SOT candidates/recipients that would identify individuals at high risk for latent tuberculosis despite negative test results. Through a careful review of posttransplant tuberculosis cases, we identify a history of treated tuberculosis in SOT recipients as a risk factor for development of posttransplant active tuberculosis. Finally, we include comparisons of recommendations by several large transplant organizations and identify areas for future research.

Web 2.0 support for residents' and fellows' patient care and educational needs.

This article discusses librarian support of medical education programs and patient care with blogs and wikis. Pedagogical background for using Web 2.0 tools in educational settings is explored and example applications given. A survey of health sciences libraries usage of blogs and wikis was conducted in 2009-2010. Using the results from the survey plus five years of experience using blogs and wikis at the University of Washington Health Sciences Library, best practices were compiled and are presented for guidance in establishing new blogs and wikis.

Relationship, communication, and efficiency in the medical encounter: creating a clinical model from a literature review.

BACKGROUND: While there is consensus about the value of communication skills, many physicians complain that there is not enough time to use these skills. Little is known about how to combine effective relationship development and communication skills with time management to maximize efficiency. Our objective was to examine what physician-patient relationship and communication skills enhance efficiency. DATA SOURCES: We conducted searches of PubMed, EMBASE, and PsychINFO for the date range January 1973 to October 2006. We reviewed the reference lists of identified publications and the bibliographies of experts in physician-patient communication for additional publications. STUDY SELECTION: From our initial group of citations (n = 1146), we included only studies written in English that reported original data on the use of communication or relationship skills and their effect on time use or visit length. Study inclusion was determined by independent review by 2 authors (L.B.M. and D.C.D.). This yielded 9 publications for our analysis. DATA EXTRACTION: The 2 reviewers independently read and classified the 9 publications and cataloged them by type of study, results, and limitations. Differences were resolved by consensus. RESULTS: Three domains emerged that may enhance communication efficiency: rapport building, up-front agenda setting, and acknowledging social or emotional clues. CONCLUSIONS: Building on these findings, we offer a model blending the quality-enhancing and time management features of selected communication and relationship skills. There is a need for additional research about communication skills that enhance quality and efficiency.

Improving your cultural awareness with culture clues.

When the University of Washington Medical Center (UWMC) administered a survey to gauge patient education support needs among staff, the results indicated a need for cultural competency. Using action methodology and needs assessment, the committee charged with developing a tool to meet this need launched a new concept: Culture Clues. These brief documents provide culture-specific patient information, allowing staff to approach patients according to their culture. The committee created six Culture Clues and is developing more.